Question time for Dr Sylvia Vigh Brisbane's Gastroenterologist and Hepatologist on "How to investigate for Ulcerative Colitis?"

Ulcerative colitis is the more common form of inflammatory bowel disease. It is thought to arise from a disordered immune system to the gut contents in genetically predisposed individuals. Below is a short outline in diagnosing this chronic relapsing and remitting disorder.

Laboratory Test

Though these are not diagnostic these are helpful in assessing and monitoring disease.

Routine bloods including FBC, ELFT

Neutrophilia

Hypoalbuminemia

Raised LFT – multifactorial

Drugs

Sepsis

Extra intestinal manifestation – primary sclerosing cholangitis (PSC)

Inflammatory markers..Non specific but aid in determination of severity of inflammation

Serological markers

Positive ASCA or pANCA no diagnostic but may differentiate ulcerative colitis from Crohn’s Disease and indeterminate colitis.

Faecal calprotectin

Sensitive marker for bowel inflammation

Not disease specific

Increased in malignancy, infections and NSAI inflammation

Useful to distinguish IBD from functional disorder

Stool cultures

Exclude infectious course, particularly Clostridium difficle as many patients have been empiric antibiotics prior to diagnosis.

Imaging

USS

CT imaging

Enteroclysis (CT or MRI)

Allow imaging of the small bowel – degree of inflammation and strictures

Endoscopic studies

Uniformly inflamed mucosa

Granular, erythematous appearance

Friability and loss of vascularity

Severe disease

Shallow ulceration (usually different to Crohn’s disease with deep serpiginous ulceration) and spontaneous bleeding

Occasional involvement of the distal ileum

Termed backwash ileitis (different appearance to true ileitis seen in Crohn’s disease with ulceration and possible strictures.)

Histological evaluation

Restricted to mucosal layer

Infiltrates of predominantly lymphocytes, plasma cells

More specific features include

Goblet cell depletion

Distorted crypt architecture

Diminished crypt density

Dysplasia – usually with long standing UC but can occur at any stage.

No criteria for diagnosis of UC but in most cases the presence of 2-3 aforementioned histologic features will suffice.

The most important thing is to consider it in your differential diagnosis and consider early referral for colonoscopy. Often patients have a delayed referral to the gastroenterologist and therefore more severe inflammation and sequelae such as muscle wasting, anaemia and hypoalbuminemia.

Please do not hesitate to contact me for referrals or patient information

Dr Sylvia Vigh

Gastroenterologist and Hepatologist

Mater Medical Centre

Ph 30105780 Fax 30105781